Monthly Archives: November 2014

As we come to the end of another year on the Transforming Workers’ Comp blog, I wanted to take some time to express what I am thankful for this year.

However, it is also a sad time, as for the first time in my life, this holiday will pass without one parent present. As many of you may know by now, my father passed away in September, and my mother and I will be having a quiet holiday without him. In fact, this past Monday, we placed him in the niche, so it won’t be the same holiday ever again.

I am also thankful for finally meeting my fellow FAU alum, Maria Todd, CEO at Mercury Advisory Group, who is encouraging me to continue my efforts to bring medical tourism to the workers’ comp industry, and who introduced me to people she knew attending the summit this year.

I am also thankful for meeting several people in the medical tourism industry that I have been connected with on Linkedin, but never met. My thanks goes to Julie Conner, Maria Laura Garcia Mesa, Elizabeth Ziemba, and of course, Carlos Arceo. I am also thankful for meeting those who I met for the first time from the United States, Canada, Mexico, and Colombia.

I am thankful for the interest my idea is finally getting, and hope that 2015 will see the realization of my idea.

And finally, I am thankful for the assistance and support of Dr. Jamie Granger, of the Business Communication department at the FAU College of Business. Dr. Granger was my professor for the course, and gave me his time and advice on how to give my presentation.

Thank you for continuing to read my blog and I wish you a very Happy Thanksgiving!

Of course, this sounds all too familiar to anyone who has read my articles in the past about immigration reform, medical tourism/travel, and its implementation into workers’ comp.

Ms. Hasstedt also said that many lawful immigrants are ineligible for coverage through Medicaid and CHIP (Children’s Health Insurance Program) during their first five years of legal residency. And as reported in today’s New York Times, undocumented immigrants are barred from public coverage, and the ACA prohibits them from purchasing any coverage, subsidized or not, through the exchanges.

In The New York Times article, Obama’s Executive Order on Immigration Is Unlikely to Include Health Benefits, the president will use his executive authority to provide work permits for up to five million people who are in the US illegally, and shield them from deportation. But his order will not allow them to be eligible for subsidized, low-cost plans from the government’s health insurance marketplace.

Ms. Hasstedt noted in her article that past immigration policy reforms, both executive (something the GOP forgot about because it was Saint Ronnie who did it) and congressional have failed to address the health care needs of immigrants.

I know there are many in the immigrant community, and among their supporters in the rest of the country who applaud the President for taking this long-overdue action due to the inaction of a Congress more in tune with the sentiments of those who like wearing white sheets, than a party whose last occupant of the White House preached “Compassionate Conservatism”.

And there are many within the Insurance and Risk Management and Workers’ Comp industry who downplay the impact immigration reform and the granting legal status to undocumented workers will have on the number of claims filed under workers’ comp.

But as I said in many previous posts, there is no way that workers’ comp can handle all of the claims that will be filed not only by legal residents, but by immigrants and those who are granted legal work status, as the President will do tomorrow night.

The medical tourism/travel industry is not perfect. Name me one industry that is. But the reality is that I have found, having attended three different conferences in the span of two years , that there are highly professional and dedicated people out there, physicians, hospitals and clinics who not only are seeking patients for private pay or group health insurance, but would probably consider taking on patients under workers’ comp, especially in the areas of orthopedic surgeries from work-related accidents, repetitive motion injuries such as Carpal Tunnel, and even weight-loss surgery, as I mentioned in my last post.

So while many in the industry are gambling in Las Vegas this week, which as the commercial says is where their money is going to stay, and where many Hispanics once called home before we showed up, it is high time to seriously consider medical tourism/travel as an option.

The influx of immigrants, and the soon-to-be announced legal status of the undocumented will put a terrible strain on an already strained health care system. It’s time to open the safety valve and let injured workers, many of them Latino, receive care in their home countries and in neighboring countries so that there are no language or cultural barriers to contend with.

Opening up a safety valve and immigration is nothing new. It’s how millions of Europeans came to America in the 19th and 20th centuries. I would not be here writing this today if my grandparents could not use the safety valve of immigration to escape what would have been a terrible fate. Thousands of Irish would have starved if they could not immigrate to the US and other countries. And millions of Chinese would have died in labor camps, famines and revolutions in the early 20th century.

But so long as the US workers’ comp system is locked away in a “padded cell”, the increased number of legal and undocumented workers with legal work status will add more demand on an already overburdened health care system.

The choice is yours. You can go with the flow of history, or stay in Las Vegas and party your way to irrelevance.

The costs associated with obesity-related work absences vary from state to state, Goldberg writes, citing a statement by the American College of Occupational and Environmental Medicine.

The statement said, in the article, that obesity accounts for about 9.3% of all absenteeism costs nationwide, ranging from 6.5% in Washington, D.C. (hey, what about all those fat cats?), to 12.6% in Arkansas (that’s after Bill Clinton left the state).

The study, it was reported, found that obese workers miss an extra 1.1 to 1.7 days of work each year compared with overweight or normal-weight workers.

“Obesity is associated with high direct costs for medical care, but the societal costs due to health-related work absences and reduced productivity could be even higher,” according to the statement referred to by Ms. Goldberg.

On a side note, my brother David is one of two physicians Board Certified in Bariatrics in the State of Delaware, and many of his patients are lower-middle class and working class, blue collar workers in the Wilmington, Delaware area, so he is well aware of the problem obesity presents to the employers in his area.

To get a picture of where the workers’ compensation industry is on this subject, a quick perusal of the articles written in the past year or so, informs us that this is an issue worth paying attention to.

Here are some of the articles I found from some of the very blogs and publications I have cited in past articles in this blog:

Another option is weight-loss surgery at a medical tourism destination, as one company in NC did with one of its employees, which I discussed in my article, US Companies Look to ‘Medical Tourism’ To Cut Costs, and reported on ABC News. Last May, I met the patient assistant featured in the ABC video at a medical tourism summit in Miami Beach. She recently reunited with the patient while on a business trip to the US, and from the pictures I saw, the woman who had weight-loss surgery in Costa Rica was a different person from the one on the video.

So, the problem of obesity in the US is getting more costly every year, and if employers, their insurance carriers, and the employees themselves want to take an aggressive and cost-effective solution to deal with this epidemic, medical tourism would be one of the options available, so that employers would not lose productivity and absenteeism from obesity would not cost billions of dollars.

And given the rising numbers of enrollees in the ACA, access to weight-loss surgery centers here in the US, may necessitate looking elsewhere, especially if costs for the procedures continue to rise, or if less expensive alternative destinations in Latin America and the Caribbean cater to such patients. Workers’ Comp would best be served by availing itself of this option.

Last week while I was drinking Indio and Dos Equis, Anthony Cirillo, president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities wrote an article in Hospital Impact entitled, “Much like airlines, hospitals nickel and dime patients”, in which he says that hospitals have learned from the airline industry how to nickel and dime patients by making up reimbursement cuts by creatively finding ways to charge extra and often hidden fees.

Mr. Cirillo cites two articles in The New York Times by Elizabeth Rosenthal. The first article, “After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know”, mentioned that a patient received a bill from an assistant surgeon he did not know was on his case. The bill was $117,000. The primary surgeon was reimbursed for $6,200, but the assistant surgeon billed for, and was reimbursed for the $117,000.

The second article, “As Insurers Try to Limit Costs, Providers Hit Patients With More Separate Fees”, discussed how providers are billing patients for separate fees such as a $1,400 emergency room fee, which the insurer paid , when a husband and wife went to a hospital for a scheduled induction of labor for their second child, and a $2,457 fee for “noncritical activation” of the trauma team in addition to the hospital’s $240 facility fee, after a woman drove her stepdaughter to an emergency room after a bicycle crash.

Cirillo said that patients do have options and choice when it comes to their healthcare. They can choose between local competitors, go cross-county, cross-state, out of state and out of country. Medical tourism continues to grow and with the increasing number of Joint Commission International accredited hospitals, employers are actively choosing to send people overseas.

This option, as I have been saying now for two years, should also apply to workers’ comp. Anyone who thinks that hospitals will not try to stick it to employers and comp carriers for their injured workers’ medical bills is sadly mistaken, fee schedule or no fee schedule.

Employers who are self-insured or who are in a state that allows them to opt-out of the statutory system, are vulnerable to this adding on of fees to the total hospital bill, on top of what the surgeon charges for the actual operation, much the same way patients in the two articles by Ms. Rosenthal were.

When the bill came from the hospital in which my father passed away in, the total bill was over $200,000. I looked through it to see if there were any charges that did not seem right, but could not find anything out of place. With his health insurance paying the majority of the bill, our portion was still over $900.

Cirillo also stated that as high-deductible plans become the norm, these fees impact consumers directly and then cause health premiums to rise in tandem. Sure, he states, there are legitimate fees typically not reimbursed, but then there are the wink and the nod fees that have become so commonplace that they fade into the background and people are numb to them just like the airline charges.

Some employers have high-deductible workers’ comp policies, and it would be incumbent on them and their brokers to explore alternatives to extra and added-on hospital bill fees, and as Mr. Cirillo said, medical tourism can be one such alternative.

Julius Caesar once said, “Veni, vidi, vici”, which means, “I came, I saw, I conquered.” While my week in Mexico was not as world-shaking as Big Julie’s, it was eye-opening and informative.

First, let me state that our host did a wonderful job in preparing the conference center, the town of Reynosa, and the surrounding area for the 5th Medical Tourism and Wellness Business Summit in Mexico. We were greeted warmly, and they were very friendly to us, and gave us some lovely gifts, both in the hotel and in the hospital some of us visited on the last day of the conference.

We also visited some dental clinics in Nuevo Progreso, a town on the Rio Grande/Rio Bravo border, a half an hour or so east of Reynosa. Two of the dentists received their training in the US; one at Baylor, the other at Loma Linda in CA.

The fact that some of us did not speak Spanish was a drawback, but there was an interpreter who did his level best to translate the speakers into English from Spanish, and into Spanish from English.

I met many people from the US, Canada, Mexico, Argentina, and Colombia. Some were medical tourism facilitators, i.e., brokers, other were doctors, dentists, and business people. Some of them I already knew online and met for the first time, and two I did not know were attending.

The entertainment Wednesday and Thursday afternoon was very good, with one Tejano band made entirely of teenage and younger boys. Also, tried my first taste of tequilla. And my last.

I now have a clearer picture of the quality of medical care in northeastern Mexico, and if I am fortunate enough to be invited back again next year, will try to attend the next summit in Puerta Vallarta.

From the little I could get in translation, the Mexican government, the various medical tourism clusters, and the business community in Mexico all agreed that they need a national medical tourism strategy, and it is hoped that this Summit is a step in the right direction.

Quotes

“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”

– Muhammad Ali

“If people are not laughing at your goals, your goals are too small..”

– Azim Premji

“Those who say your dreams are ridiculous have given up on theirs.”

– Unknown

Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.

– Thomas Carlyle

“As the work is done for the employer, and therefore ultimately for the public, it is a bitter injustice that it should be the wage-worker himself and his wife and children who bear the whole penalty.”

– President Theodore Roosevelt, 1907

To permit every lawless capitalist, every law-defying corporation, to take any action, no matter how iniquitous, in the effort to secure an improper profit and to build up privilege, would be ruinous to the Republic and would mark the abandonment of the effort to secure in the industrial world the spirit of democratic fair dealing.

– Theodore Roosevelt, 1908

“The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”

– John Kenneth Galbraith

“Only a fool would try to deprive working men and women of their right to join the union of their choice.”

– Dwight D. Eisenhower

“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”

– Thomas Jefferson

“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”

– Andrew Jackson

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”

– Abraham Lincoln

“Do not go where the path may lead; go instead where there is no path and leave a trail”

– Ralph Waldo Emerson

“Some men see things as they are and say why. I dream things that never were and say why not.”

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

– Karl Marx

“The secret of change is to focus all of your energy, NOT on fighting the old, but on BUILDING the NEW.”

– Socrates

“Every man takes the limits of his field of vision for the limits of the world”

– Arthur Schopenhauer

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

– Arthur Schopenhauer

“You have enemies? Good. That means you’ve stood up for something, sometime in your life.”

– Winston Churchill

“No matter what people tell you, words and ideas can change the world.”

– Robin Williams

“There can be no equality or opportunity if men and women and children be not shielded in their lives from the consequences of great industrial and social processes which they cannot alter, control, or singly cope with.”

– Woodrow Wilson

“Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative.”

– John Stuart Mill

“The masters of the government of the United States are the combined capitalists and manufacturers of the United States.”

– Woodrow Wilson

“The test of our progress is not whether we add more to the abundance of those who have much it is whether we provide enough for those who have little.”

– Franklin D. Roosevelt

“Of all the forms of inequality, injustice in health [care] is the most shocking and inhuman[e]…”